Fear Factor: Shyness Isn't Just A Stage Kids Go Through

Some Children Come Out Of Their Shells, But Others Develop Phobias That Can Be Life-crippling. Fortunately, The Serious Afflictions Are Treatable With Therapy And Medications.

April 9, 2005|By Peter Jaret, Los Angeles Times

Years ago, when parents came to him worried because their kids seemed abnormally shy, Murray Stein, a psychiatrist at the University of California, San Diego, would tell them not to worry -- that most children outgrow periods of intense shyness. "Now we're not so quick to dismiss their concern," he says.

Although most very shy kids do emerge from their shells, one in three become more troubled, according to Stein, one of the country's leading experts in childhood anxiety disorders. They go on to develop social phobia, also called social anxiety disorder -- shyness so extreme that it causes physical symptoms, such as racing heartbeats and shortness of breath, and interferes with a normal life.

As their dread of meeting people or being in the spotlight intensifies, they withdraw more and more from the world.

"These are kids who eventually drop out of college because they're so terrified of being called on in class," says epidemiologist Ronald Kessler, a professor of health-care policy at Harvard Medical School who studies anxiety disorders. "They miss out on jobs they're qualified for because they're too afraid to go to interviews."

There are other dangers. Recent nationwide surveys that Kessler has directed show that people with social phobia are at greater risk of developing severe depression, panic attacks and substance-abuse problems. They are also more likely to commit suicide.

Given those risks, a growing number of childhood psychiatrists and psychologists say it's important to be alert to early signs of problem shyness.

"Social phobia has the earliest onset of almost any mental disorder," says Stein. "People with the earliest onset generally fare the worst. So if we can intervene and treat children or adolescents early, we may be able to help prevent more serious problems later."

Fortunately, the disorder has turned out to be among the most treatable of all mental conditions.

MEDICATIONS GET JOB DONE

Several classes of prescription drugs that were first developed to treat depression or anxiety have been shown to relieve the symptoms of social phobia in many sufferers. The newest and most widely used are selective serotonin reuptake inhibitors, or SSRIs, which were first developed to treat depression. To date, the U.S. Food and Drug Administration has approved three SSRIs specifically for social phobia: paroxetine (Paxil), sertraline (Zoloft) and venlafaxine (Effexor).

The drugs appear to work in both children and adults. A 2004 University of Texas study of 319 children and adolescents with social phobia found that 48 percent were "very much" improved after taking Paxil, compared with 15 percent of those on a placebo.

Another approach is psychosocial therapy, which uses counseling to encourage people to face their fears, overcome them and then develop social skills to feel more comfortable in the company of others.

"Exposure is a powerful tool," says Thomas Rodebaugh, associate director of the Adult Anxiety Clinic at Temple University in Philadelphia. "When the worst thing people fear doesn't happen, they begin to lose that fear."

In practice, many mental-health experts use both medication and counseling to treat social phobia.

The toughest challenge, experts say, is getting help to the people who need it most. Only about 15 percent of people with serious social phobia seek medical help, surveys suggest, making it one of the most undertreated of all psychiatric disorders.

"Most extremely shy people are just too shy to ask for help until their problems become so severe that they feel they have no other choice," Kessler says.

Recent surveys have shown that more and more adults are troubled by shyness. The reason, experts suspect, is that society places a high premium on being outgoing and vivacious.

"There used to be many more opportunities for people who were socially shy and reticent to live in small communities, work at home and limit their social interactions," says Stein. "Now, particularly as women have entered the workplace, people have to interact more. If you want to get ahead, you have to be out there in people's faces."

The percentage of people who have true social phobia is very small -- only 3 percent to 4 percent of the population, according to Stein.

According to the official definition, the disorder is a "marked and persistent fear" of certain social or performance situations. Those with social phobia experience anxiety that can approach the intensity of a panic attack. To qualify as a disorder, extreme shyness also has to interfere with the ability to function at work, in school, or in personal relationships.

That children are often unaware they have a problem is just one of several factors that make diagnosing and treating young patients tricky. Another is knowing whom to treat.

"We know that some very shy children will outgrow it," says Stein. "Some will go on to have serious problems. Unfortunately, we're still not very good yet at knowing who we should worry about."